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. 2021 May 6;2(7):1107-1114.
doi: 10.34067/KID.0006852020. eCollection 2021 Jul 29.

Outcomes among Hospitalized Chronic Kidney Disease Patients with COVID-19

Minesh Khatri  1 , David M Charytan  2 , Sam Parnia  2 , Christopher M Petrilli  2 , Jeffrey Michael  2 , David Liu  2 , Vasishta Tatapudi  2 , Simon Jones  3 , Judith Benstein  2 , Leora I Horwitz  2   3
Affiliations

Outcomes among Hospitalized Chronic Kidney Disease Patients with COVID-19

Minesh Khatri et al. Kidney360. .

Abstract

Background: Patients with CKD ha ve impaired immunity, increased risk of infection-related mortality, and worsened COVID-19 outcomes. However, data comparing nondialysis CKD and ESKD are sparse.

Methods: Patients with COVID-19 admitted to three hospitals in the New York area, between March 2 and August 27, 2020, were retrospectively studied using electronic health records. Patients were classified as those without CKD, those with nondialysis CKD, and those with ESKD, with outcomes including hospital mortality, ICU admission, and mortality rates.

Results: Of 3905 patients, 588 (15%) had nondialysis CKD and 128 (3%) had ESKD. The nondialysis CKD and ESKD groups had a greater prevalence of comorbidities and higher admission D-dimer levels, whereas patients with ESKD had lower C-reactive protein levels at admission. ICU admission rates were similar across all three groups (23%-25%). The overall, unadjusted hospital mortality was 25%, and the mortality was 24% for those without CKD, 34% for those with nondialysis CKD, and 27% for those with ESKD. Among patients in the ICU, mortality was 56%, 64%, and 56%, respectively. Although patients with nondialysis CKD had higher odds of overall mortality versus those without CKD in univariate analysis (OR, 1.58; 95% CI, 1.31 to 1.91), this was no longer significant in fully adjusted models (OR, 1.11; 95% CI, 0.88 to 1.40). Also, ESKD status did not associate with a higher risk of mortality compared with non-CKD in adjusted analyses, but did have reduced mortality when compared with nondialysis CKD (OR, 0.57; 95% CI, 0.33 to 0.95). Mortality rates declined precipitously after the first 2 months of the pandemic, from 26% to 14%, which was reflected in all three subgroups.

Conclusions: In a diverse cohort of patients with COVID-19, we observed higher crude mortality rates for patients with nondialysis CKD and, to a lesser extent, ESKD, which were not significant after risk adjustment. Moreover, patients with ESKD appear to have better outcom es than those with nondialysis CKD.

Keywords: CKD; COVID-19; SARS-CoV-2; chronic kidney disease; dialysis; end stage renal disease; mortality.

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Conflict of interest statement

D.M. Charytan reports having consultancy agreements with Allena Pharmaceuticals (for serving on a data and safety monitoring board), Amgen, AstraZeneca (for serving on a data and safety monitoring board), Eli Lilly/Boehringer Ingelheim, Fresenius, Gilead, GlaxoSmithKline, Janssen (for serving on a steering committee), Medtronic, Novo Nordisk, and PLC Medical (for serving on a clinical events committee); receiving research funding from Amgen, Bioporto (for clinical trial support), Gilead, Medtronic (for clinical trial support), and Novo Nordisk; serving as a scientific advisor for, or member of, CJASN; and receiving expert witness fees related to proton pump inhibitors. S. Jones reports having ownership interest in Methods Analytics (London, United Kingdom; 1% share). All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Cohort flowchart. COVID-19, coronavirus disease 2019; Cr, creatinine.
See this image and copyright information in PMC

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